HEALTH INSURANCE FAQs:

  • The CID has authority over fully insured plans written in Connecticut. These are policies that a consumer or employer buys from a health insurance company, generally paying a monthly premium. Under a fully insured plan, the insurance company assumes the risks and pays the claims for covered services and treatment.
  • Fully insured plans must adhere to all state insurance laws and regulations. The CID monitors insurance companies doing business in the state to ensure ongoing compliance with such state insurance laws and regulations.
  • The CID does not regulate self-funded health plans. These are plans that many employers use. The employer decides what services and treatments will be covered and the employer’s funds are used to pay claims. A third-party administrator, such as health insurance company or other licensed entity is used to administer the health plan. In some cases, the CID has limited authority over these third-party administrators.
  • Self-funded plans are regulated by the federal government, specifically the U.S. Department of Labor under the Employee Retirement Income Security Act (ERISA).
  • The CID does not regulate Medicare or Medicaid. These programs are regulated by the federal government through the Centers for Medicare and Medicaid Services.
  • The CID does not regulate plans written out-of-state. You will need to contact the insurance department in the state where the plan was written.
  • Other plans not regulated by the CID include Tricare, VA Benefits, federal employee plans and postal workers.

  • Yes. State law requires health insurers to pay claims promptly or be subject to 15 percent annual interest, and any other penalties that may be applicable by law.
  • Claims must be paid within 20 days if your provider submits them to the insurer electronically.
  • For claims filed on paper, the insurer has 60 days to pay before being assessed late penalties.
  • Medical discount plans (MDP) are NOT health insurance but do provide a discount on a participating provider’s normal fee for services.
  • If you have health insurance but it does not cover certain services such as dental or vision, an MDP card may be beneficial.
  • You should only buy an MDP card from an organization that is licensed by the Connecticut Insurance Department, because many MDPs operating nationwide are unlicensed and may not offer quality health benefits.
  • Contact the Insurance Department before you buy an MDP card to verify it is licensed and legitimate. You can reach us at 860-297-3850 or email insurance@ct.gov.

  • It is the law in Connecticut that urgent care requests submitted to health insurers, which includes certain mental health and substance use disorders, be handled in an expedited manner.
  • If your policy requires pre-authorization, also known as utilization review, your insurer must give you an answer within 24 hours for these issues.
  • That same 24-hour standard applies for appeals of denials for such services.
  • If your appeal is denied you have the right to have a third-party review the insurance company’s decision through the Connecticut Insurance Department’s External Review Program.
  • There are steps you can take ahead of time:
    • Contact your insurer before receiving services to get any pre-authorization needed.
    • Whenever possible use an in-network provider. Your insurer can help you find one.